Elsevier

Burns

Volume 35, Issue 8, December 2009, Pages 1097-1103
Burns

Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars

https://doi.org/10.1016/j.burns.2009.06.206Get rights and content

Abstract

We compared the efficacy of silicone gel (Scarfade®), silicone gel sheet (Epi-Derm™), and topical onion extract including heparin and allantoin (Contractubex®) for the treatment of hypertrophic scars.

Forty-five postburn scars were included in the study. Patients with scars less than 6 months from injury were assigned at random to three groups each containing 15 scars, and their treatment was continued for 6 months. Scars were treated with Scarfade®, Epiderm™ and Contractubex®. Scar assessment was performed at the beginning of the treatment, and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale.

The difference between before and after treatment scores for each three groups was statistically significant. The difference between Scarfade® group and Epi-Derm™ group was not significant; however, the differences of the other groups (Scarfade®-Contractubex®, Epiderm™-Contractubex®) were significant.

Silicone products, either in gel or sheet, are superior to Contractubex® in the treatment of the hypertrophic scar. The therapist should select the most appropriate agent according to the patient's need and guidelines of these signs.

Introduction

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis [1]. A significant problem following thermal, postsurgical and traumatic injuries is the development of hypertrophic scarring. Postsurgical, traumatic, and burn scars can be painful, pruritic, erythematous, raised, and cosmetically unacceptable.

Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. A wide variety of treatments have been advocated for abnormal scars including surgical excision and/or grafting, occlusive dressings, topical and intralesional corticosteroids, interferon, cryosurgery, radiation, pressure therapy, laser therapy, retinoic acid, and silicon gel sheeting as well as a multitude of extracts, topical agents, and other promising, lesser known therapies directed at collagen synthesis [2], [3], [4], [5], [6]. We have commonly used topical silicone gel, silicon gel sheeting, and topical onion extract in routine outpatient practice; and to our knowledge, there is no report that compares the efficacy of the these products to each other for the treatment of scars. In this study, we compared the efficacy of topical silicon gel, silicon gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars.

Section snippets

Material and methods

Thirty-two patients who had no treatment for hypertrophic scars previously with a total of forty-five postburn scars were included in the study. Hypertrophic scars which were occurred by burns (except chemical burns) were included in the study for standardization as far as possible. The criteria for patient selection are shown in Fig. 1. Approval and consent were obtained from The Haydarpasa Training Hospital Institution's Research and Ethical Review Committees. Informed consent was obtained

Results

All patients tolerated the treatment and they could use silicone gel sheet at least 12 h daily in group II. Because two patients who were treated with silicone gel sheet developed skin maceration and pruritis, the treatment was interrupted for a week until complaints disappeared, and application duration of the gel sheet was shortened. Any problem was not observed in the other two groups. A CONSORT diagram is shown in Table 3 to assess for bias in enrollment.

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Discussion

Various mechanisms of action have been proposed about topical silicone materials on hypertrophic scars [9]. Silicones are synthetic polymers based generally on a dimethyl siloxane monomer and containing a silicon–oxygen backbone, with organic groups attached directly to the silicon atom by silicon carbon bonds [1]. Depending on the length of the polymer chain and degree of cross-linking, the silicone can be a fluid, gel, or rubber [10]. Silicones are believed to decrease scar via wound

Conflict of interest statement

There are no conflict of interest statements.

References (15)

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